A Medication to Treat Anorexia?

Autism and anorexia have wildly different public faces. The stereotype of an autistic person is a little boy obsessed with trains or a brilliant coder with no social life, while the eating disorder victim is typically pictured as a driven young woman or girl, whose whole world revolves around presenting a carefully drawn picture of thinness and social perfection.

While stereotypes never capture the whole story, underlying both conditions is a rigid obsessiveness that appears within the first few years of life, as well as difficulties reading and responding appropriately to social signals. Not to mention, two of the major triggers for anorexia are a profound sense of alienation and sensitivity to social ranking, according to Dr. Janet Treasure, professor of psychiatry and director of the eating disorders unit at King’s College in London.

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Evidence that oxytocin, a brain chemical also known as the “love hormone,” can help autistic people pay more attention to social cues and make socializing less stressful prompted Treasure to explore what effect it would have on anorexia. Now, three new studies of the hormone—best known for its role in bonding lovers to each other and parents to their children—suggest that it may indeed be a viable treatment for anorexia, which currently has no effective pharmacological medication and relies for the most part on therapy.

In the first study, published in Psychoneuroendocrinology, when anorexic women were given placebo and asked to look at images of food or pictures of various body parts or shapes that were either thin, fat, or not associated with weight (like eyes), they paid much closer attention to food pictures and to the fatter body shape images than the healthy control group. But when they were given intranasal oxytocin, they showed less interest in the food and shape-related pictures, making their reactions more like those of the healthy women. Moreover, the more autistic traits the women with anorexia had—for instance, a preference for repetition and sameness, strong interests, and difficulty reading people—the more effective oxytocin was at normalizing their responses.

In a second study, published in PLOS ONE, oxytocin was found to decrease the attention anorexic women paid to disgusted faces, while increasing vigilance to angry ones. “Disgust is very much a signal of not being ‘in with the in crowd,’” says Treasure. “I think people with anorexia do feel those putdowns and social ranking [very intensely].” And when it comes to rage, “anorexic patients suppress anger a lot,” says Treasure, “and yet, inside, they have a lot of anger and frustration.”

Dr. Eric Hollander, Director of the Autism and Obsessive Compulsive Spectrum Program at Albert Einstein College of Medicine and Montefiore Medical Center, who was not associated with the study, agrees that people with anorexia often find anger unacceptable or even toxic in themselves and others. Consequently, he says, “they develop these habits where they [react to] those emotions both through restriction of food and feelings of low self worth.”

Environmental exposures and experiences can affect which genes for oxytocin receptors are expressed and therefore, influence behavior. So in a third study Treasure and her colleagues looked at how anorexia affects the expression of these genes. What they discovered was that women with anorexia did have some specific variations in the expression of oxytocin receptor genes, which might reduce levels of the hormone and cause a deficiency. These changes were linked with the severity of their disorder. It’s unclear, however, whether these alterations predispose women to anorexia or whether they are caused by starvation, which is known to affect gene expression.

The new studies “suggest that within anorexia, there’s a dimension related to autistic-like behavior,” says Dr. Hollander. Researchers like Treasure have previously suggested that anorexia might, at least in some cases, be a form of autism seen more commonly in girls. A girl with a rigid desire for sameness and an obsessive bent might be more likely to focus her interest on food restriction in a culture that prizes thinness in girls, while a boy with those same tendencies might develop more typically autistic obsessions. And some research has found that the same genes can influence risk for both conditions.

Aside from the intriguing link between autism and anorexia, all three studies point to a new direction for anorexia research that focuses on treating its underlying biology, rather than changing psychological factors. “It needs to be much more brain directed,” says Treasure. “Talk therapy can only do so much.”